slept with, is sleeping with you" whilst another positioned females as sexually predatory "One roll-on all women want" (Figure 5). Inboth instances, the myth of youth promiscuity is reinforced, with attribution of blame oriented towards male youth (specifically black male youth in the first instance) and a black female in the second and females as irrepressibly sexually wanton in both. These themes and images resonate with constructions in the early part of the loveLife programme, and are regularly reiterated through research and other discourses over time. Moral panic thus services an ideological end of legitimating the 10veLife programme by positioning 10veLife as regulating irrepressible youth sexuality.
Figure5:loveLife billboards
One roll-on all women
evaluation, which involves analysis of the consequences specific to the intervention in relation to specific indicators; impact evaluation, which analyses the degree to which the programme's objectives have been met; and economic evaluation, which involves cost-benefit analysis of the intervention (see Mantell, DiVittis & Auerbach 1997, Gentry, Gilliam, Hotgrave & Sy 2002). Evaluation is directly linked to policy and strategy, and provides guidance as to whether activities and programmes are meeting stated objectives, whether they should be continued in their present form, or whether they should be modified or discontinued. In relation to
mv
prevention programmes, policy questions include behavioural impacts (short and long-term),mv
incidence reduction, replicability, generalisability, cost effectiveness, emphasis in relation to spending on other diseases or emphasis on particular communities versus others (Holtgrave 2002). In the early phases of the HIVIAIDS epidemic there were often only a limited number of interventions addressingmv
prevention. These interventions engaged relatively well-defined and geographically contained 'target' groups, with the result that it was possible to define, monitor and evaluate interventions directly against programmatic inputs, and to draw conclusions accordingly (see Mantellet a11997; Gillies 1998).In the context of a generalised
mv
epidemic however, there is a wider complex of mechanisms that relate to individual perceptions of the epidemic, and over and above interventions there are other discourses and experiences that frame individual constructions and responses to the epidemic. These include internal psychological processes; interaction with others through dialogue; sense-making that includes a location in socio-cultural responses to the epidemic; knowing a person who ismv
positive or who has died of AIDS; being
mv
positive oneself, and so on. This is described in Table 1 below, in relation to communication.Table 1:Forms of HIVIAIDS communication
ACTIVITY COMMUNICATION COMPONENT EXAMPLES
Mass Media HIV/AIDS
·
Television programming and Typically conducted by government and NGOs, Campaigns (purposive) advertisements but including purposive activities of broadcasters·
Radio programming and and other media formationsadvertisements
·
HIV/AIDS related advertisements·
Print articles and advertisements·
HIV/AIDS related dramas, documentaries,Outdoor signage features
· ·
HIV/AIDS related columns, talk shows·
HIV/AIDS related sloqans, sonqs Mass Media content·
Television programming·
HIV/AIDS content within news dramas,(non-purposive)
·
Radio programming documentaries, features·
HIV/AIDS content within columns, talk shows,·
Print articles letters pagesHIV/AIDS small media
·
Leaflets, brochures, booklets, Typically produced as part of HIV/AIDS campaignsbooks or awareness activities
·
Exhibitions, flip charts, stickers,·
HIV/AIDS related leaflets, brochures, booklets,posters, signs, murals books
·
HIV/AIDS related exhibitions, flip charts, stickers, posters, signs, muralsHIV/AIDS events
·
Events, meetings, gatherings Typically conducted by government and NGOs·
Theatre, drama·
HIV/AIDS related events, meetings, gatherings·
HIV/AIDS plays, puppet shows, story telling HIV/AIDS policy·
Announcements Typically conducted by organisations working in discourses·
Conferences, meetings, the HIV/AIDS field including government, NGOs, workshops foundations, donor agencies, Charities, policy·
Events agencies, research organisations, lobby groupsand elites. Includes communication about:
·
Journal articles, reportsHIV/AIDS Research
· ·
HIV/AIDS Policy and legislation·
HIV/AIDS related campaigns and programmes HIV/AIDS public·
Announcements, press releases, Statements emanating from government officials, relations discourses press conferences or persons in organisations as well as other elites,·
Conferences, meetings, public and/or popular figures. May include workshops statistical claims, claims to impacts, statements·
Public relations events including about the past, present or future.launches, press conferences
HIV/AIDS icons and
·
Photographs, images, Artworks Items that may include aesthetic and/or utility artefacts·
Quilts, memory boxes value such as photographs, AIDS quilts, memoryUtility items boxes
HIV/AIDS structured
· ·
Structured interactive Typically conducted as !!Jart of campaigns andinteractive communication programmes
communication
·
HIV/AIDS related school-based lifeskills(conversation-based) programmes
·
HIV/AIDS related helpline services, social services·
HIV/AIDS related counselling, structured dialogues·
HIV/AIDS related workshopsSocial action and Communication as a product of
·
Wearing/using HIV/AIDS related utility items mobilisation involvement in HIV/AIDS activities·
Attending meetings, gatherings, rallies·
Formal or informal HIV/AIDS work including prevention, treatment, care and support activitiesInterpersonal dialogue Conversations, arguments, Wide-ranging communication relating to contextual
discussions experiences of HIV/AIDS
Table 1 outlines the complexity of sources of mY/AIDS information via discourse.
Purposive mass media campaigns form only one aspect of a wide range of communication related to the epidemic. These discourses are also not necessarily consistent in terms of content and include a range of purposive and non-purposive constructions. The notion therefore, that causal pathways can be established by particular content (for example, emanating from 10veLife) inserted into one or more discourse channels, is problematic.
Approaches to monitoring and evaluation by 10veLife have largely focused on reach of the programme - for example, quantifying the number of billboards, the number of advertisements broadcast, print media coverage,S? or calls58
made to the national helpline (IoveLife 2003b), as well as knowledge of, and interaction with, programme elements, and causal claims (IoveLife 2002b, 10veLife 2004b). This approach does not take into account the potential impacts of parallel mY/AIDS interventions, let alone the complex of factors that might influence my prevention amongst youth.
In the early phases of the 10veLife campaign, evaluation activities were mainly small scale. These were summarised in a report (IoveLife 2001a) and in a journal article by researchers connected to the programme (Stadler & Hlongwa 2002).59 The summary report includes information on a number of research studies, and is characterised by the provision of only limited information on research methodologies and sampling approaches. In this report there is information relating to a number of 'surveys' that were conducted to assess brand equity; overall effectiveness [of the campaign] and message take-out. Two brand equity 'surveys' were conducted and both are described under the following premise: "In order to assess the brand equity and overall effectiveness it was necessary to generate data that was random and from
57 Which includes the outcomes of public relations activities by the loveLife programme.
58 An emphasis is placed here on counting calls to the line whether they were answered or not, as well as omitting information on the qualitative nature of the call - specifically whether it was a 'genuine' or hoax call. Hoax calls are a significant problem for South African toll free helplines, sometimes reaching levels of 80% (see Parkeret ai,2003b).
59 The article by Stadler and Hlongwa entitled 'Monitoring and evaluation of loveLife's AIDS prevention and advocacy activities in South Africa' appeared in an apparently peer-reviewed academic journal,Evaluation and Program Planning,which provided added legitimation to the findings. This particular issue of the joumal was, however, a special issue produced in partnership with UNAIDS and loveLife funders UNICEF and was not peer reviewed through the normal process. Instead, articles were selected and reviewed by UNAIDS and UNICEF. Personal communication, lonathan Morell, Editor:Evaluation and Program Planning, 15 March 2004.
which generalizations can be made. Two national surveys served this purpose"
(loveLife 2001 a: 16).60
The 'national' surveys were conducted by Research Junxion (Survey One) and Kaufman, Levine and Associates (Survey Two) respectively, and are described as having sample sizes of 'n=1000' and 'n=141 '. Survey One comprised 600 adolescents aged between 12 and 17, and 400 adults over 25 years of age 'stratified by gender, race and settlement type' who were interviewed using a 'closed questionnaire interview'. Survey Two is described as 'random sample of 70 taxi rank adults and 92 school children' comprising 'short interviews of five minutes' in schools and at taxi ranks (age ranges are not mentioned). Expanded information on methodologies including sampling representivity, are not provided.
Findings are presented in narrative form, and are supported by tables and pie charts.
Results are presented as percentages. Survey One: "The national survey... revealed that more than half(57.5%) of the total sample population had heard about 10veLife.
Black urban respondents reported higher rates (66.7%) of exposure than white (only urban) respondents (45.7%)" (loveLife 2001a:17). And in Survey Two: According to Research Junxion's national survey almost half of the respondents (41.8%) perceive 10veLife's aim to 'encourage safe sex', while 23.4% felt that it aimed to prevent mY/AIDS and 35.2% felt that it was to warn about the risks associated with sex such as teenage pregnancy." (loveLife 2001a:19). The third survey employed 'theatre techniques' with white (n=110) and black (n=107) respondents between 12 and 50 years" (loveLife 200Ia:23).
In these studies, a claim is made to national representivity, in spite of small unrepresentative sample sizes, as well as unclear methods of sampling. In claiming national representivity, and then masking actual numbers by focusing on percentages, a form of ideological direction takes place whereby skewed and insubstantial research is represented as being true of the whole of South Africa and generalisable nationally. This is further reinforced through the prominent use of tables, bar graphs and pie charts (see Figure 6).
60 Italics added.
Figure 6:Interpretation of 'The future aint .. .'
Whit.
o
llaci
o
-
-
No....
~
-l----~
1
rr.ctin safe -
8~~~~~
-~ . l . . - I_ _...,
I No ... - -01 AIDS E:~IB~B~-...J
I
I
40%
Figure 12: Interpretation of The Future Ain't WhatIt Used To Be (Source: Impact Information)
OOtl'llloowp
AlIlSI...ml.lJ~
l==:::J
AlDSkJllIl===~
WIUl.
D
Block
D
' - - - -
Rgure 13: Interpretations of the loveUfe campaign overall _ (Source: Impact Information)
Leading closed ended questions are also used in these studies - for example: "The message provides important information on how to avoid HIV/AIDS (42.7%)"; "The message caught my attention and made me think about issues of sex (35.2%)"; "The message caused me to talk about sex and HIV/AIDS to others" with only one extreme negative option "The message used crude language and was embarrassing (3.1 %)". Successes are claimed sans caveats, and inferences to national representivity and impact are reiterated:
In just under 12 months loveLife has succeeded in creating national recognition among close to 60% of the population. And over 90% of people who know about loveLife can accurately
identify it as a safe sex campaign promoting healthy living for young people. More than 80% of people surveyed rated loveLife as an effective new approach that has caused them to think and talk about sex and HIVIAIDS. loveLife has had a remarkably balanced impact across age groups and regions, but has definitely had greater impact among black South Africans than whites. (loveLife 2001a:25l1
Sustaining monocausality
Key to the 10veLife's causal argument is the negation or masking of potential impacts of other campaigns, even though in some instances this information may be gathered as part of survey activities. For example, as part of a 2003 evaluation of the 10veLife programme, questionnaires included references to Soul City and the Red Ribbon Campaign. Figure 7a shows an initial draft copy of the survey.62 This information was omitted from the final report (see Figure 7b).63 This suggests that an intentional process of ideological masking has taken whereby deference is given to a monocausal construction of the 10veLife programme's reach.
61 Bold text added.
62 The initial draft report was not made available in the public domain, but was provided on condition of anonymity.
63 See Pettifor et al 2004.
Figure 7a: 2004 Draft Survey
% ~1 ~.
19IU ~7 6217 7238 ~ 3S56 2131 3a2 2S35
Although jus under two-thirds of youth reported knowing of any na lonal HIV programmes/campaigns, when they were specifically asked if they had heardorseen particular HIV prevention programmes, 85% of youth reported hav heardorseen loveLife,91%of young people reported having heard ofSOUlCityand 90%had heard orseentheRed Ribbon Campaign. There were no sign' cant dilTerences in awareness of any programmes by age or gender.
For all three national campaigns, more youthliVingInu formal areas reported being aware of them compared to youth living in farm areas; for example,93%of youth living in urban formal areas compared 065% ofyouth/tving in farm areas had heardorseen
Iovelife.
.... ..
KnowledgeofThree National HIVlAIDS CampaignsbyGeographic Area
.... "'"
--
~~~"':...
P:==·::::::'=~---1I":.
"
..
I---...Lj':.
' - - ...J . . . .
.... " ..
t - - - ,....::!.-..
Figure 7b: 2004 Final Survey
I
- - -..-
:1_1_ 1!tI....
,s.."
~ 1....-,- ....
,..".'50". _
_ l a...
~.00,... _ _ _ _
... f.1'lIo flIl\,
5,.. n.""
70,., 5Il'1o '<.'!O"IoI"" . ,:/''>; .~ 1,... ~
...'" c..;r41
rr.o,~r:;;
.f
t_ ".114
$'" IZ1l ~Z. ~'" !MO ll~' ~U, z~n
Al~1 h ~hlld IMrll'd~oryolhre ed ~ro or~lIoiI~ona.l 41'o11'o(!i,l mp;N flo;ly wetoSpo.:i'lcaIy3~.ecll'tIWly ~110 d tl:.&Gnlho '6lUoyO"ptO\'oo'iOncam gn3~IlinuJtanoor.J
~....," tt"<oloo'J.e5'~vfyoulil\~oclhcrvftll ordOfGOOnbvoLeo. Trcro .... noc;io;llllnc.ll1ldr!loron"Ofiin .J....~~o!IOYt U'obyOgoQr90I'lCIOr.
As has been previously noted, 10veLife's evaluation research has fostered claims- making with regard to causal relationships between knowledge of 10veLife intervention and responses of sexually active youth to (leading) questions that suggested 10veLife had brought about condom use (78%) and reduction in sexual partners (69%) at national level (IoveLife 2002b). The later 2003 survey was considerably more rigorous, and included a comprehensive approach to sampling that generated a final sample size of 11 904. The survey questionnaires and methodologies were reviewed by various research experts, as was the final report.
Although, as is noted above, key information was left out of the final report, the section on perceptions of the 10veLife programme contradict previous assertions of massive impact:
While being aware of loveLife and partlclpating in its programmes is an essential element, it is hoped that through this interaction youth will change their behaviour or act in some positive way as a result. Among all youth, 24%reported that they had done something as a result of what they saw or heard about loveLife. Fifteen percent of all youth report having talked to someone about loveLife as a result of what they saw or heard.
Fewer reported looking for more information on sex, sexuality and relationships(4%), looking for more information on loveLife (3%), or calling ThethaJunction (1%). Sixty-one percent did nothing as a result, and16%had not heard of loveLife. When all youth were specifically asked whether they had communicated with others about loveLife, 33% reported having talked to someone about it. Of the 33% of youth who reported talking to someone about loveLife, the majority (74%) reported talking to friends. Fewer indicated they had talked to a teacher or classmate (11%), a partner(8%), a sibling(7%), or their parents (5%). (Pettifor et al 2004:71)
Although the inclusion of this finding is surprising, it does not necessarily follow that suggestions of negligible impact by the programme would be incorporated into subsequent discourses or into other discourse genres. Instead previous constructions were reiterated in other discourses. In the 2004 10veLife brochure (2004c), which was launched at the same time as the survey, for example, previous causal claims from the 2002 survey were prominently reiterated in the text. This ideological direction extends to the brochure's cover, continuing the practice of inferring that
loveLife is an impactful programme, and failing to defer to the later findings reported in 2004 (See Figure 8).
Figure8:2004 brochure cover
Over-emphasis on quantification in evaluation research is noted to be problematic as it masks individual experiences of health interventions. MacPhail and Campbell (1999) note that quantitative approaches essentialise the notion that individuals control and determine their health through improvements in knowledge, awareness and 'self-efficacy' whilst masking the complexities that underpin individual responses. As Springett points out:
In the promotion of health, we are looking at complex social phenomena requiring complex interventions. Those interventions may take the form of a project or programme but equally could take the form ofa policy or an innovative social change. There is no 'magic bullet', but multiple strategies producing multiple
outcomes, some intended and some not. There is also no clear linear relationship between input and outcome. Any given outcome is usually the product of complex interactions between factors and concepts. Any evaluation framework needs to be flexible enough to capture this. (2001 :141)
Given that evaluation research is "the process of determining the worth, merit, or significance of entities, and evaluations [reports] are the outcome of that process"
(Scriven 1998:80) there is a need for sound methodologies and objective distance.
Emphasis on evaluation as a framework for 'proving' interventions rather than 'learning' about interventions is problematised by Springett (2001), who points out that pre-determined measures and indicators give little consideration to the perspectives of the subjects upon whom the intervention has been imposed.
Evaluation research cannot be divorced from the range of interests that exist around a given intervention. Poor performance against objectives is likely to have negative consequences for further funding of programmes, and may also prove embarrassing to stakeholders who have endorsed the programme. In the case of 10veLife, there is much at stake, and there is a need for the organisation to tread carefully by balancing, on the one hand, a stated commitment to comprehensive monitoring and evaluation (loveLife 2002c; 2003a), and critical reflection of the programme's impacts and cost effectiveness. Internal commissioning and control of monitoring and evaluation processes ensures that critical questions and analyses are not pursued (with the notable exception of two paragraphs in the 2004 report); that other interventions are excluded from the frame of reference (i.e. the omission of references to Soul City and the Red Ribbon campaign); and that the conditions underpinning youth vulnerability to my are masked by the causal assumptions tied to the 10veLife programme (i.e. knowing only about 10veLife).
Research and evaluation reports are complex documents, and there is a need to ensure that interpretations are not skewed by misunderstanding - particularly when reports are released to the media. This requires careful management of the process of inserting research findings into the public domain. In the case of the 2004 report, Health-e, a Kaiser Family Foundation (KFF) funded news service, was utilised to actively support the launch of the report. Five media reports were produced and released to the media.64This allowed for particular interpretations of the report to be represented - for example: "A major new survey found that 'younger teenagers' are
64 See www.health-e.org.za (7 April 2004).
mostly
mv
negative", with additional commentary by loveLife CEO Harrison: "If we can enable them to stay that way, we can turn off the oxygen tap constantly fuelling the flames of the epidemic" (The Star, 7 April 2004:3).65 Other articles incorporate commentary from Harrison, loveLife researchers and other individuals.All five press releases emphasise the first section of the report that dealt with HIV prevalence amongst youth, with no reference made to the finding that loveLife's impacts were negligible. In effect, a preferred reading was inserted into the public sphere through the capacity to control discourse production processes via KFF funded Health-e. Furthermore, the potential for a critical reading by other journalists was reduced - for example, it was unlikely that editors would commission an independent journalistic review of the report (including seeking commentary from independent researchers) when five pre-packaged articles were available. This level of control is enhanced by active partnerships between Health-e and various newspaper groups who benefit economically through not having to produce or pay for news articles, as well as partnerships and contracts between newspaper groups and loveLife, which limit the likelihood of critique. Repetition (see Therborn 1999) of the same interpretations of the findings is used extensively across the five Health- e articles - for example, shifting discourse towards identifying gender disempowerment as a 'driving force' underpinning HIV prevalence: "According to David Harrison ... one of the key factors driving this gender disparity is the fact that women are exposed to a greater degree of coercion" (The Star, 7 April 2004).66 Harrison also fosters the construction of new 'folk devils' - "For Harrison, the country's 'violent culture of death' associated with violent crime, the high road- accident rate and the cheap cost of life contributed to this nihilistic attitude" (The Star, 7 April 2004:7).67 These strategies constitute shielding (see Therborn 1999)- whereby particular discourses are protected, and critiques are kept outside the discourse frame.
65 Ndaki, K. (2004, April 7) AIDS survey shows teens are future's hope,The Star.Ndaki is an employee of Health-e.
66 Ndaki, K. (2004, April 7) Shock AIDS facts about our youth,The Star,7 April 2004.
67 Ibid.